Surgical bandage,constrictive device,and inflatable means



July 8, 1969 R, w. LILI IGRN ETAL SURGICAL BANDAGE, coNsTRcTIVE DEVICE,AND INFLATABLE MEANS Filed May 8, 1967 E 6'3 INVENTORS P06/52T MlL/.16min BY JOHN C. MILLER United States Patent Office 3,454,010Patented! July 8, 1969 3,454,010 SURGICAL BANDAGE, CONSTRICTIVE DEVICE,AND INFLATABLE MEANS Robert W. Lilligren, 3109 Palos Verdes Drive N.,Palos Verdes Estates, Calif. 90274, and John Clifton Miller,

1105 Shasta, Vallejo, Calif. 94590 Filed May 8, 1967, Ser. No. 636,744Int. Cl. A61m 1/00; A61b 17/12; A61h 1/00 U.S. Cl. 128-327 9 ClaimsABSTRACT OF THE DISCLOSURE A surgical bandage, for preoperativetreatment of a limb, utilizes pneumatic pressure to compress the bloodand lymphatic vessels and to express the normal fluids from the limbbelow a previously placed tourniquet and prior to its inflation. Thesein turn provide a dry surgical field. A second use for the device is toreduce the volume of the vascular tree by multiple limb compression inthe immediate treatment of shock.

BACKGROUND OF INVENTION Heretofore it has been common surgical practiceto tightly wrap a substantially nonstretchable bandage around a patientslimb in order to express fluids from the limb in preparation forsurgery, reliance being placed upon the constant application ofconsiderable tension to the bandage in order to wrap it tightly enoughto drive out the fluids. This requires considerable muscular effort onthe part of the surgeon and is quite time-consuming. It is also commonpractice to utilize tourniquets to inhibit the flow of blood in a limbthat is being operated.

In the prior patented art, the patents to Ferrier, No. 2,699,165, and toWeinberg No. 2,781,041, disclose inatable boots for treatment ofvascular disorders in limbs by alternately subjecting the limb tofluid-energized compression and decompression. Such devices are ofrelatively complex and expensive construction and are designed to bereused repeatedly. They are not adapted for presurgery use.

The patent to Hoflinger discloses an inflatable boot for collectingblood at a selected point in the human body. This device is likewise ofcomplex construction and not adapted for presurgery use. The patent toKoski et al., No. 2,943,859, discloses an inflatable arm-stitfening bandwhich also is not suitable for presurgery use.

SUMMARY OF INVENTION This invention provides a constrictive bandagewhich comprises a flat, ribbon-like tube of thin fluid-imperviousmaterial such as plastic film, having a series of fluid cells traversingit laterally and connected at opposite sides so as to provide a path offluid-flow communication gradually progressing along the length of thebandage, whereby air or other gas injected into one end of the bandage,will progressively inflate the cells from one end of the bandage to theother. The cells are connected by ports of suflicient restriction toretard the progressive inflation of the cells suiciently toautomatically control the successive application of pressure to a limbthat is helically wrapped with the bandage, in a manner such as toeffect the gradual collapse of the limbs uid fvessels and the gradualdriving of the uid along the length of the limb, until the level of thetourniquet is reached and the distal limb cleared of blood and lymph.

The bandage is provided with means to effect attachment of successiveturns of the bandage to one another, with the adherence beingintensified as the bandage is inflated, the adherence being adequate toprevent the opening of gaps between the turns of the bandage. Thebandage is pre-sterilized and of inexpensive construction and thusdisposable, being designed for use only once.

The object of the invention is to provide an inexpensive preoperativebandage which can be wrapped helically around a patients limb withoutthe necessity for pulling it tight during the wrapping, which, afterbeing fully Wrapped around the limb, will develop constrictive tensionas the result of inflation thereof, which will thereby applyconstrictive pressure to the limb commencing at one end of the wrappedbandage and progressing gradually to the other end of the bandage so asto drive the limb fluids out of the wrapped area, which can easily bepierced by the surgeons scalpel after a tourniquet has been applied tothe proximal or body end of the evacuated area to prevent return of uidsinto the area, thus allowing the air to escape `and collapsing thebandage, and which can be discarded when the operation is concluded.Sterility of the bandage eliminates the need for a portion of the usualsterile drapes and further reduces operative time and expense.

DESCRIPTION This and other objects will become apparent in the followingspecifications and appended drawing, wherein:

FIG. 1 is a side view of a human leg wrapped in a bandage embodying theinvention;

FIG. 2 is a plan View of an end portion of the bandage;

FIG. 3 is a cross-sectional view of several inflated turns of thebandage, as wrapped around a limb;

FIG. 4 is a cross-sectional view through a modified form of the bandage;

FIG. 5 is a fragmentary plan view of a bandage embodying anothermodified form of the invention;

FIG. 6 is a sectional view of several inflated turns of the bandage ofFIG. 5;

FIG. 7 is a longitudinal sectional view of a portion of the bandage ofFIG. 5, taken on line 7--7 of FIG. 6;

FIG. 8 is a fragmentary cross-sectional view of another modified form;and

FIG. 9 is a fragmentary cross-sectional view of another modified form.

Referring now to the drawing in detail and in particular to FIGS. 1-3,we have shown therein, as an example of one form in which the inventionmay be embodied, a bandage constructed from a flat tube of thinheat-scalable plastic film material such as polyethylene tubing, theends of which are closed, as by seams 10 and 11 consisting of transversebands of heat-sealing. An inflation fitting 12, including suitable means(e.g., valve or clamp) for closing it after inflation, is secured in thesealed end seam 11, with its inner end communicating with the interiorof the tube alt that end.

The tube is divided by transverse seams 13 of heatsealed junctionbetween the tubing walls into a series of transverse air cells 14 whichare interconnected along the sides of the bandage by constricted ports15 formed as short spaces between the ends of heat-sealed bands 13 andthe side folds 16 of the tubing.

The first cell, 17, communciating with tting 12, may :be triangular,defined between the first transverse band 13 and diagonal bands 18spreading outwardly from fitting 12.

The external surface of the tubing material is provided with anonslipping surface such that the successive turns of wrapping willadhere to one another sufficiently to prevent separation of the turnswhen inflated. The nonslipping surface may be a roughened (pitted orpebbled or grained) surface in the tubing wall, as at 22, or it may be alayer of pressure-sensitive adhesive 23 (FIG. 4) applied to one face ofthe bandage and adapted to adhere to the other face of an adjacent turnin the wrapped bandage, or it may be a strip 24 of pressure-sensitiveadhesive (FIG. extending l-ongitudinally along one face of the bandagein a position to engage and adhere to the overlapped area of an adjacentturn, as in FIG. 6, or it may be a covering of igauze 25 (FIG. 8) on theouter or both faces of the tubing, secured thereto by the heatsealing ofbands 13 (the heat softened tubing material adhering to the gauze duringheat-sealing).

In the use of the bandage to prepare a limb (e.g., a patients leg forsurgery, it is wrapped around the limb in successive helical turns, asillustrated in FIG. 1, with successive turns overlapping to asubstantial extent (e.g., in the range between a substantially 50%overlap as shown in FIG. 3 and a substantially 331/3% overlap as shownin FIG. 6).

Where a pressure sensitive adhesive covering one face of the bandage isutilized as in FIG. 4, the overlap may be as small as approximately 20%,as shown in FIG. 4, or somewhat less, so long as it is adequate toprovide continuous air-cell coverage along the length of the limb, witha portion of the inflated area of one turn overlapping that of aprevious turn as shown. In this construction, the adhesive may -bepermitted to directly contact the patients skin and to hold the turns intheir proper positions by adherence to the skin. The adhesive employedin such instance is of mild adherence, easily stripped away from theskin without injurious pulling. FIG. 4 shows the bandage in uninatedcondition.

As shown in FIG. 9, the adhesive may be applied in diagonal stripes 29.

The bandage in each instance is wrapped around the limb under justsufficient tension to place the turns in snug overlapping contact andwithout any slack along the length of the bandage. The beginning end ofthe bandage is held in place by an assistant until secured by successiveturns. When wrapping is completed, the end (e.g., strap portion 20) issecured, as by pinning or by wrapping a band of surgical adhesive tapearound the end turn of the bandage or by use of tie strings or otherequivalent securing means, or at the users discretion, by hand pressureuntil inflation of the device and the tourniquet is completed.

The bandage is then inflated by applying an air pressure hose or othercompressed gas supply device to fitting 12, so as to force compressedair or other Igas into that end of the bandage. The air will flow intothe first cell 17 and from that cell through the constricted ports 15into successive cells 14 along the length of the bandage, travellinghelically around the limb and progressively compressing the limb withhoop tension such as to gradually drive the limb fluids toward thepatients body (the air injection being effected at the end of thebandage nearest the limb extremity). As each successive turn of thebandage is inflated, its constrictive pressure will be somewhat greaterin its central area 33 than in the area 34 of its margin which iscovered by an uninflated turn, but as the latter turn is inflated, itwill apply compression to such marginal area of the previous turn, thusbringing the pressure thereof up to the maximum in the inflatedpreceding turns. The net result is a creeping wave of constriction ofwhich the front is of somewhat lower intensity than the maximum pressurewhich is developed in the fully inflated turns following the front. Thisavoids any trapping of fluids in the limb in areas that have been passedby the compression wave.

Inflation may be effected by use of an air hose, or by carbon dioxidefrom a CO2 cartridge or from a Kidde- Tourniquet, or by lgas pressurefrom a Zimmer Inilatomatic tourniquet, or other suitable source ofpressurized gas, whether air, CO2, freon, nitrogen, helium or other gas.The same source of gas pressure may be used to inflate both the bandageand the tourniquet 32.

,A tourniquet 32, previously applied around the limb, is thenconstricted (e.g., by inflation) so as to prevent any return ow Offluids into the bandaged limb. When the tourniquet is constricted andsecured, the surgeon proceeds with the surgery. Optionally, he may firstunfasten the bandage and remove it from the limb, or he may simply cutthrough the bandage with his scalpel at the point where the incision isto be started. The severed turns of the bandage can then be allowed todrop away from the limb, and the uncut turns of the bandage can beretained in place to function as a surgical drape.

Where the bandage of FIGS. 5-7 is employed, it may be wrapped around thepatients limb -with the strip of adhesive disposed on the outer face ofthe bandage on the covered side which is overlapped by a succeedingturn, or on the inner face of the covering side which overlaps aprevious turn, so that the adhesive strip adheres to an adjacent turn ofthe bandage rather than to the patients skin. Reliance is then placed onthe bandage becoming, in effect, a continuous boot with the turnsattached to one another. The same is true to a somewhat lesser extent inthe bandage of FIG. 3, the roughened surfaces of the bandage clutchingone another when pressed together by the air pressure in the inflatedbandage, so as to establish non-slipping interengagement which isassisted by non-slipping engagement of the roughened surfaces of theexposed inner faces of the turns against the patients skin.

Where the bandage of FIG. 8 is employed, the gauze surfaces willinterlock with one another to provide nonslipping coupling :of thesuccessive turns, one to the other.

An important feature of operation of the bandage is the circumferentialforeshortening which arises from the outward distention of the Walls ofcells 14 (FIG. 7) which tends to draw the seams 13 toward one another asindicated by the arrows. Since the bandage does not shiftcircumferentially, the seams 13 cannot actually be displaced, and thenet effect is to build up hoop tension in the turns of bandage, whichcauses the constricting pressure to be applied along the fullcircumference of each turn, beneath the seams 13 as well as beneath thecells 14.

The bandage can be produced in varying lengths for use on limbs ofvarying sizes. For unusually large limbs, several shorter bandages canbe attached, end to end and inflated successively, the inflation of thesecond one being delayed until the first is completely inflated.

By way of illustration of one possible means of securing the tape at theend of the wrapping, a fastener tape is indicated at 36 in FIG. l.

iInflation means 12 includes a hose of sufficient length to extendbeyond the sterile field of operation, and includes a bacterial lter 37which is positioned to fall outside said sterile field.

We claim:

1. A bandage for pre-surgery use in driving fluids from an area of apatients limb to be operated, and for reduction of vascular tree volumein the immediate treatment of shock, when wrapped around the limbhelically in successive turns, comprising:

a length of generally flat tubing of thin plastic sheet materialincluding:

longitudinally-spaced transverse seams defining within said tubing aplurality of gas cells,

each of said seams having at least one end thereof spaced from anadjacent side of the tubing to define a series of restrictetd portsinterconnecting said cells,

means on at least one face of said bandage for engagement with the otherface thereof in a succeeding turn of the wrapped bandage, such as toprovide non-slipping attachment of successive turns to one another,

and means at one end of the bandage for injecting gas under pressureinto the cell at that end, whereby to effect progressive inflation ofsuccessive turns of the wrapped bandage from one end to another so as todrive out fluids from the wrapped portion of the limb.

2. A bandage as dened in claim 1, wherein said tubing is lofheat-sealable plastic material and said seams are heat-sealed strips ofjunction between the opposed tubing walls.

3. A bandage as dened in claim 2, wherein said tubing is of polyethylenematerial.

4. A bandage as defined in claim 1, wherein said restricted ports areprovided at both sides of the bandage.

5. A bandage as defined in claim 1, wherein said nonslipping engagementmeans comprises a roughened surface on said tubing.

6. A bandage as dened in claim 1, wherein said nonslipping engagementmeans comprises a facing :of pressure-sensitive adhesive on a face ofsaid tubing.

7. A bandage as -dened in claim 1, wherein said nonslipping engagementmeans comprises a longitudinal stripe of pressure-sensitive material onone =face of said tubing, located nearer one side of the tubing than theother.

`8. A bandage as dened in claim 1, wherein said nonslipping engagementmeans comprises a plurality of longitudinally spaced diagonal stripes ofpressure-sensitive adhesive extending transversely of said tubing.

9. A bandage as defined in claim 1, wherein said nonslipping engagementmeans comprises a covering of gauze having portions thereof embedded inand thus attached to said seams.

References Cited UNITED STATES PATENTS 2,044,691 6/1936 Hoinger 12S-3272,272,48 1 2/ 1942 Rinkes et al.

2,699,165- 1/1955 Ferrier 128--60 3,164,152 1/1965 Nicol] 128-87 L. W.TRAPP, Primary Examiner.

U.S. Cl. X.R. 12824, 299

